IGF-1在慢性肾脏病糖皮质激素性骨质疏松患者诊断中的意义

目的 探讨慢性肾脏病糖皮质激素治疗的骨量异常患者体内血清胰岛素样生长因子-1（IGF-1）水平与此类患者骨密度变化的关系以及在骨质疏松症诊断中作用.方法 选择本院长期使用糖皮质激素、病情稳定的骨量异常的慢性肾脏病患者20例进行观察,另择骨量正常患者10例为对照组,分别进行骨密度、骨代谢及生化指标测定.结果 骨量异常组与对照组相比,血IGF-1及Ⅰ型前胶原氨基端前肽（PINP）显著降低（P＜0.01）,Ⅰ型胶原C末端肽（CTX）水平升高（P＜0.05）,血钙、血磷、全段甲状旁腺素（PTH）、AKP水平差异均无统计学意义（均P ＞0.05）.血IGF-1与骨密度值及血PINP正相关,与CTX负相关,与血PTH、AKP、血钙、血磷间无相关性.结论 血IGF-1不仅可反应骨转换水平高低,而且与慢性肾脏病糖皮质激素性骨质疏松（GIO）患者骨密度值的变化相平行,在GIO早期诊治和严重程度的判断中具有重要临床价值.

Serum IGF-1 levels in diagnosis of glucocorticoids-induced osteoporosis in patients with chronic kidney disease

Objective To evaluate serum insulin-like growth factor-1 （IGF-1） levels in the early diagnosis of glucocorti- colds-induced osteoporosis in patients with chronic kidney disease. Methods The serum levels of procollagen type I, N-terminal propeptide（ PINP ）, c-terminal telopeptide of type I collagen（ CTX ）, IGF-I and other biochemical indicators were determined; the bone densitometry were checked in 20 patients with chronic renal disease and 10 healthy controls. The results were analyzed with SPSS 11.5. Results The serum levels of PINP and IGF-1 in patients with chronic kidney disease complicated with glucocorticoids-induced osteoporosis were statistically lower than those in controls （P〈0.01）. The serum CTX level in the patients was higher than that of controls （P=0.012）. The serum IGF-1 level was positively correlated with bone density and serum PINP, and negatively correlated with serum CTX level. Conclusion Serum IGF-1 level can be used for early diagnosis of glucocoticiods-in- duced osteoporosis in patients with chronic renal disease.